Branch Pulmonary Artery Valve Implantation Reduces Pulmonary Regurgitation and Improves Right Ventricular Size/Function in Patients With Large Right Ventricular Outflow Tracts.

Objectives: The authors sought to assess the intermediate-term effects of percutaneous placed valves in the branch pulmonary artery (PA) position.

Background: Most patients with large right ventricular outflow tracts (RVOTs) are excluded from available percutaneous pulmonary valve options. In some of these patients, percutaneous branch PA valve implantation may be feasible.

Seeing in different ways: introducing "rich pictures" in the study of expert judgment.

In this article we explore the value of using visual data in a study on medical expert judgment to better understand medical experts' conceptualizations of complex, challenging situations. We use examples from a larger study on medical expertise in which rich pictures and interviews were used. The three stories presented in this article belong to experts in the domain of surgery.

What's behind the scenes? Exploring the unspoken dimensions of complex and challenging surgical situations.

Purpose: Physicians regularly encounter challenging and/or complex situations in their practices; in training settings, they must help learners understand such challenges. Context becomes a fundamental construct when seeking to understand what makes a situation challenging and how physicians respond to it; however, the question of how physicians perceive context remains largely unexplored. If the goal is to teach trainees to deal with challenging situations, the medical education community requires an understanding of what "challenging" means for those in charge of training.

Catheter-directed thrombolysis with tPA to restore renal function after iliac venous thrombosis post-renal transplantation.

Background: Successful salvage of a failing renal allograft secondary to compromised venous outflow from acute deep venous thrombus (DVT) has not been reported in the post-operative setting.

Case Report: We present a case of acute DVT extending from the popliteal vein to the bifurcation of the inferior vena cava leading to renal allograft dysfunction in the post-operative period. The allograft was successfully salvaged with catheter directed thrombolysis of the DVT with tPA through the ipsilateral popliteal vein over a 48 hr period.

Discussing withdrawing and withholding of life-sustaining medical treatment in a tertiary paediatric hospital: a survey of clinician attitudes and practices.

Aim: To better understand current attitudes and practices relating to discussions concerning the withholding and withdrawing of life-sustaining medical treatment (WWLSMT) among medical staff in the paediatric setting.

Methods: An anonymous online survey of paediatricians (senior medical staff - SMS) and paediatric trainees (junior medical staff - JMS) likely to be involved in the care of children with life limiting illness.

Results: A total of 162 responses were obtained (response rate 42%).

Social identity and self-enactment strategies: adapting to change in professional-manager relationships in the NHS.

Significant variation has been identified concerning the impact of management agendas on health professionals in the National Health Service. While attempts to explain these responses among health professions have identified a range of factors to account for such differences, existing research is still unable to explain the sources of variation that can occur within professional groups. Current approaches to studying professional-management relations either attempt to explain variation between organizational contexts and subgroups at a collective level of analysis or they struggle because of the absence of a theoretical framework capable of integrating social, psychological and contextual elements that can explain the sources and purposes of differentiated individual and group behaviours.

Canadian Cardiovascular Society Consensus Conference: peripheral arterial disease - executive summary.

This Consensus Conference has been supported by the Canadian Cardiovascular Society. The process is dynamic, with intentional structure that requires peer review and feedback from cardiovascular specialists across Canada. The writing and review panel encompassed a broad range of specialists caring for the patient with peripheral arterial disease (PAD).

Doctors as managers: investors and reluctants in a dual role.

Government reform of the NHS in the UK has sought to increase the involvement of doctors (clinicians) in hospital management. Using frameworks from the psychological contract and organisational misbehaviour literatures, this paper examines the processes involved when clinicians assume management roles. This literature seeks to explain breaches to expectations regarding prior agreements with management and subsequent actions of 'getting even' as a result of breaches to the employment relationship.